=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518206309
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARGARET HUMES-BARTLO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2013
-----------------------------------------------------
Last Update Date | 02/13/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 85 CRESCENT AVE
-----------------------------------------------------
City | PASSAIC
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07055-2437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-931-2276
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39 WOODLAND DR
-----------------------------------------------------
City | WOODCLIFF LAKE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07677-7842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 35S100484300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------